It is no great revelation to understand that no matter what business you are in, your success will depend on your ability to build trust and above all to develop trustworthiness. In that post I described the Trust Equation: T=C+R+I/S, where T stands for trustworthiness, C for credibility, R for reliability, I for intimacy and most importantly, S stands for self-orientation.

By far, the key to building trust is to increase the numerator and diminish the denominator…in other words to lower the degree to which you are self-focused.

But how do you do that? My last post implied that you just do it (I hate when I get self-righteous), because it’s more difficult than you might imagine. In fact it’s the essence of good leadership and falls under the categories of knowing oneself, self-awareness, self-management, empathy and social skills. It requires the uncanny ability of executive attention, or focusing to the degree of shutting off your emotional brain.

Most of the time we operate from our emotional brains…it’s the default. When we don’t pay attention our minds wander. When our minds wander—they wander to the self…increasing self-orientation and raising that denominator.

The key to reducing that number is to practice attention training…I’ll get to how in a second.

Dan Goleman, in his new book Focus, says, “Stopping on cue is the holy grail of cognitive control.” By that he means that once we realize we have been emotionally hijacked we need to stop and correct. In other words become more mindful.

After years and years of practicing dentistry, and fighting off my own demons (like an over-awareness of myself), I agree with Goleman that attention training and mindfulness is the key. But it takes practice. In my book I write about practicing the soft skills, but mindfulness practice can go a long way in helping you to develop the trustworthiness you will need to become an effective presenter.

What kind of practice?

Meditation, (Goleman suggests twenty minutes per session at least four times per week), and breathing exercises.

For me…I do meditate and I do hot yoga. Both of these have done wonders for me physically but I can also tell you that the focus needed for both, slows the mind down…so I can become more aware…and just stop it when I am thinking of myself too much.

Simple? Yes. But not easy.

Or…just take the advice that Bob Newhart gives to his patient in the classic comedy skit that you can click on above.

Enjoy the video — it’s hilarious…and there’s a lot of wisdom and business sense in here too.

Many dentists are under the impression that presentation is a specific, isolated procedure. In my new book I make

the very important point that presentation is not a system or a process...it’s an approach. Through over the 200 plus pages of the book I continually make that point.

Recently, a new patient entered my practice. She found me on the Internet (through a piece of the Art of Presentation known as Cyberbranding, that is discussed in the book). Her chief complaint was discomfort–sore muscles to be specific). Her bigger problem was that she had a failing 6 unit upper anterior bridge.

She has a dentist.

Her dentist was in the process of making her a new provisional when she told him of her discomfort. He told her to get that fixed first…but he never referred her…so she found me…by Googling…TMJ specialist…and my name came up #1.

But it’s here where the real adventure begins.

She has a dentist. She trusts her dentist. Her intuition told her to stop and get the TMJ problem solved first.

My job…is to take very specific information that I will gather up in a comprehensive examination, and find a way to explain it to her, in a way that makes sense to her. Along the way I find many bumps in the road…mostly centered around trust and money. My first bump is explaining the need for the complete examination.

She said she had radiographs taken recently. She brought them with her. Bitewings and a few periapicals revealing the failing terminal abutment of the bridge.

Within a few minutes, by addressing her chief complaint (pain) and relating it to the musculature (by showing her the relationship of muscle contraction and canine guidance…my masseter shuts down while her’s continues to fire), she sees some light.

John Kotter in his book, The Heart of Change, describes the most effective way to persuade people is to use a method he calls See, Believe, Do. That’s what I did…showed her. She then believed me and she did the exam.

It’s that quick. But I still didn’t relieve her pain…just her confusion.

The next step is to prescribe splint therapy. This takes time. She’s already told the other dentist to halt the provisional until she gets comfortable.

I know the splint will work. I’ve made a few in my time. The more difficult part of this case is to change her thinking…change her beliefs about dentistry…see, believe, do.

The splint will do that. No pictures of beautiful cosmetic dentistry of how she will look. No convincing her of how good my work is or that I am an artist. No photography.

So by showing her the care she was looking for by attending to her chief complaint, and by by providing her with a solution that will actually relieve the pain she can then go forward and address her bigger long term issue...because I exhibited care and competence…the two components of TRUST.

In my forty years of practicing dentistry I never had the opportunity to tell a patient, “It’s a boy!”

“You need a root canal,” aren’t the words that most people want to hear. There’s a reason why comedians have picked on dentists for years. If I hear the root canal metaphor one more time it won’t be too soon.

Persuading people to get their teeth fixed is a bit more difficult than selling cars or puppies. I know…I sell puppies. People come looking and they always leave a deposit. I wish my front desk had it so easy.

There’s a reason sales professionals created something called the “puppy dog close.”

The closest thing we have to a puppy dog close is the trial smile, or cosmetic mock up. But we can’t tell the patient to take it home for the weekend like a beautiful puppy. A photo will have to do.

I can discuss needs vs. wants till the cows come home but the problem, as I see it, it’s what Avram King expressed years ago when he said you want your patients to be paying with “happy dollars.”

I really think this was the reason why the cosmetic dentistry revolution started. Dentists realize that complete dentistry is a tough sell, what with all the objections, so they grabbed onto the most obvious visible benefit.

But esthetics shouldn’t be the driving force behind dentistry. Hiding beyond the idea that everyone wants a beautiful smile (well, not everyone), is that everyone wants to keep their teeth (yes, everyone).

Strangely, not everyone likes dogs, but even still puppies are quite persuasive. It’s a 55 billion dollar per year industry.

So how do dentists fulfill their obligation to help people keep their teeth? Yes, I do believe it’s an obligation and if you are a dentist reading this, and you have other thoughts, I would like to hear from you.

It starts with leadership. It really is about becoming the change you want to see in the world. That is why I wrote my new book The Art of Case Presentation...to teach dentists there is no way of closing someone on keeping their teeth. No gimmicks, no manipulative tricks. Case presentation, persuasion, and leadership are all one. An approach to practice and life.

Persuading patients to lose weight, stop smoking or get their teeth fixed will never be as easy as persuading them to take one of those dachshunds home…but that’s part of our job. If we can do that- then just like Sinatra said about New York—“if you can make it there, you can make it anywhere.”

For a short time I will be offering the Art of Case Presentation at a 25% discount by clicking on the ADL Newsletter sign up button.

There are many books dentists can read to get better at presentation. Most of the books can be found in the Sales and Marketing section of your local bookstore. It seems that over the years I have read most of them. Add to those the numerous books on philosophy and psychology and I could write my own book. Hmm…I already have.

Great book…lots of practical information, but like so many books it falls short on specific advice for my day to day experiences with patients.

Let me give you an example.

S.P.I.N. is a process or series of questions that guides your patient interview. It starts with Situation questions, Problem questions, Implication questions and finally Need payoff questions.

Essentially it is a guide to uncover the patient’s real problems and for you to fit that problem with your solution (payoff).

The real crux of Rackham’s system comes with finding the right implications. In other words—what’s the real meaning behind the problem?

This is what most sales trainers call the WIIFM part of the presentation…the benefit. And this is what they used to call in the Bronx…what separates the men from the boys.

The very best have a way of drilling down to uncover the real problems and their emotional implications.Most of us have heard the sales saying, “People buy on emotion and justify on logic.”

Well the very best understand that and always think in terms of implications.

For example, I had a patient who resisted getting her front tooth fixed until her husband refused to go out in public with her anymore. Fix the tooth for health reasons? For functional reasons? For comfort and appearance?

No way.

But when the idea of not being accepted came up…she was in my office in a New York minute (second reference to the Big Apple).

Yes sitting high up on Maslow’s Hierarchy of Needs is that need to belong.

It is their own particular circumstances and their own story that we need to explore in order to find what moves them. That is why I advocate a complete examination that focuses on knowing our patients.

As a coach I hear stories like these all the time…specific incidents where the dentist says: “What do you say when they don’t see the problem, or when they tell you this objection or that.”

I tell them there are no words…just a mindset which includes lots of empathy and thinking about emotional implications.

Think in terms of implications — be preventive, so your patients don’t leave with regrets—“I could have had a V-8.”

In the comments below—leave some specific situations where thinking in the language of emotional implication has helped you or created frustration.

In my next blog post I will give you an example of “selling ideas” rather than dentistry that just might improve your relationship with your laboratory.

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Ralph had a dilemma. He was in severe pain and had lots of dental fear and “no money.” But he wanted to save his teeth. I guess that’s more like a tri-lemma or a quad-lemma. According to the dictionary, a lemma is a premise or a theory. Ralph had three or four premises working against each other. Anyway, he was not happy when I first met him.

Have you met many Ralph’s in your practice? I guess so. One thing about these issues – pain always wins. Pain beats fear, pain beats money and pain beats time.

This is a moment of truth…not for the patient, but for the dentist. Let me explain.

Most dentists, when a new patient arrives, look at the patient’s mouth and see a final result. Their vision of a beautiful smile overcomes them and they start presenting dentistry, either in a positive or negative way. But the dentist who is concerned with real change, and making a real difference will step inside the shoes of the patient and see the world from their point of view.

Ralph has been unemployed for three years. His financial picture looks bleak. Through further conversation we come to find out that Ralph said he had “no money” and he was jobless…but he has a home and a wife who works. This doesn’t make him Rockefeller but he still wants to keep his teeth.

So what does Ralph really need?

If you said a plan, you are right. Ralph needs a long-term plan. A long term treatment plan that will take into account his financial circumstances.

This may sound obvious, but I don’t think it is common practice. Creating plans and having in depth discussions are not what many dentists enjoy doing. They like to fix teeth.

Yet…the real “art” of dentistry lies in the ability of the professional to effect real change. That’s what artists do—they create—they create change.

Too many dentists think the art of dentistry lies in their veneers or their bonding. I disagree. Dentists call themselves artists…yes, even patients refer to them as artists, when most dentistry isn’t art at all.

When I ask dentists how they can be more creative in their practices, I mostly get blank stares.

Today, I used theArt of Examination and the Art of Case Presentation to help Ralph make a decision. A first step. That is not what he woke up thinking this morning…and I made those changes…created that change without picking up my drill.

Many years ago, as a young dentist, at a study club meeting I heard a dentist say he gets patients to accept treatment by “gloomin and doomin em.” That never sat well with me…I just knew it was wrong.

Still, I think, many dentists gloom and doom their patients. Not intentionally as was prescribed, but more out of habit or even frustration. One of the things dentists need to do is to stay optimistic. Not only for their own survival but also for their patient’s ability to make healthy choices.

There is so much negativity around dentistry. It costs too much, it hurts, it takes so long…we all know what patients tell us. Not real good for morale. So when the dentists adds doom and gloom to the mix, that only makes it worse.

Leaders close emotional gaps. In the case of dentistry our job is to bring patients from where they are to where they could be. That’s the gap.

Not the intellectual gap but the emotional gap.

Too many dentists are like Jack Webb, the police sergeant on the old TV show, Dragnet. They just give patients the facts. Webb’s character, Sergeant Friday was famous for saying, “Just the facts mam, just the facts.”

Well, dentists aren’t cops and we don’t enforce the law. I like author, E.M. Forster’s classic lesson on story: “The king died, and then the queen died vs. The king died and then the queen died…from grief.”

See the difference between that and “Just the facts mam?”

Abe Maslow told us that people are motivated by fulfilling needs. Four of those needs are self-interest, self-actualization, belonging and hope for a positive future.

The job of a dentist is to close that emotional gap by painting pictures of positive, hopeful futures. Our role is to motivate and lead…or else our role is that of a tooth mechanic or a repairman.

The entire profession needs to see the dentist’s role as one of leadership. Only then will the profession shed the negativity associated with dentistry.

Is there any time I use gloom and doom?

Not really…but sometimes I use “shock” to get someone’s attention…but that’s another story.

Becoming a great presenter is a requirement for leadership. Avoiding the 5 deadly sins of presentation is one step in the right direction toward becoming a leader.

I find that dentists commit these sins on a routine basis, and in this age of mega-information it behooves dentists to get their point across as fast and effectively as possible.

1. No Clear Objective. Many dentists just present from the hip without thinking about what action they want the patient to take. It’s a good idea to write down exactly what you want the patient to do as a result of your presentation. This will serve two purposes…you will know if you are successful and it will keep you focused during the presentation.

2. The Presentation is Too Long. Case presentations or any presentation shouldn’t take longer than 20 minutes. It’s way too much information for anyone to digest. When you are focused on the action you want the patient to take, then you will present only what is necessary for them to make a decision. If you see their eyes glazing over…you have lost them.

3. No Benefit. People will accept treatment when they understand the benefits. Usually those benefits are emotional. Don’t present the features of the work you are going to do…just tell them WIIFM (What’s in it for them).

4. Too Detailed. It took a long time for you to get through dental school. Now it’s time to condense that education into a succinct understandable presentation…not a lecture. Albert Einstein said, “If you can’t explain it simply, you don’t understand it well enough.”

5. No Clear Flow. Find a way to organize your presentation…the best way is to use story as your structure. My new book The Art of Case Presentation explains how to structure presentations with story.

Prepare your next presentation avoiding these mistakes and observe how much better you do…remember the objective.

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I don’t mind talking about dentistry…anywhere, anytime. So, when a friend approached me in the gym and asked how business was, I told him, “It’s been slow.” He then felt compelled to tell me, “Well, if you guys would lower your fees, you’d get more business,” as I stared at the gap in his smile that he never fixed.

Funny how people reduce complex problems down to a simple cause. Most people can’t live with the idea of unsolved complex problems. The answer to getting more business into a dental practice is not to simply lower fees.

But I love to talk dentistry, so I told him a story.

I asked him to imagine a dental experiment in which a dentist did the exact same procedure on ten different patients. Let’s say it was a simple single surface filling on a lower molar. He was following me because he was familiar with the terms filling and molar. I didn’t want to confuse him, and I didn’t know how much dentistry he knew.

The procedure, I told him, required an injection, some drilling and then putting in the filling. He nodded. Then I asked him, “Do you think the procedure would be exactly the same for each patient?”

He gave me an understanding look…he was a master of the obvious. He said, “No, each patient was different.”

“Yes, some would move, some would cry, some would scream, some would salivate too much…the variables are endless…and those ten scenarios only included the patients who made it for their appointed time,” I said.

Once again, full comprehension.

So I asked, should the fee be different for each one?

Now he looked baffled…actually upset, stymied, dumbfounded. No answer.

I felt sorry for him, because my intention is to educate not aggravate, so I proposed a different solution:

“What if the dentist added a drug to the Novocaine that filled each patient with a high level of trust…love almost. A strong feeling of attachment was created by this drug.”

He laughed and said, “Sure…can’t ever happen.”

“What if I told you that the drug already exists…and actually we humans can create our own.”

I had his attention.

“It’s called oxytocin. It’s a hormone and a neurotransmitter (was pushing it with this word) that women secrete during childbirth. I even use it as a dog breeder to help the girls give birth and start lactation. It’s been called the hormone of love.”

He was wondering where I was going with this, so he said, “Why don’t you guys use it?”

“Because it’s not available here in the U.S. The Swiss have a version that’s inhalable. But we really don’t need it. Recent research shows that if a person feels that they are around someone or something that expresses love, trust or the desire to bond, then their levels of oxytocin increase. In other words we can manufacturer it ourselves.”

“So what good does that do us,” he said.

“Well, if there wasn’t all of this distrust in our culture, if there wasn’t so much self-interest going on, if people , including dentists didn’t worry so much about getting theirs, well, that would be a solution.”

“When pigs fly, ” he said.

Not really, if each of us takes the responsibility to really care about the other…things will change. If not, capitalism in health care will need more and more regulation. Or we can just lower our fees.

By the way this conversation was a presentation of sorts…can you see why?

Do dentists see themselves as creatives? I don’t mean mean dentists who write or paint…but rather in their everyday practice of dentistry. It is my belief that people bring creativity to their job…and dentists are no exception.

In many ways dentists are like writers. Let me explain.

Years ago, before I created my examination process, I would gather up all of the information from the clinical examination: the radiographs, the models and the charts. These days I have added study models and photographs. Either way, I would sit down at my desk, get a cup of coffee, close the door and get ready to create my plan. Sometimes I gave thanks that there wasn’t much to do…a simple case. Other times, especially when the amount of material I collected seemed overwhelming and confusing, I would sip my coffee and look blankly at the viewbox. I would pick up the models, and many times nothing came to me.

It was the same feeling I would get when I get writer’s block. Brainfog.

There are many ways to cure writer’s block, like going out for a walk and coming back later, but when you’re facing a deadline you have to produce something. When a reporter gets writer’s block he just writes a bad article. When a dentist gets writer’s block he creates a bad treatment plan.

Writers use outlines and other techniques like freewriting to create ideas. Mind maps work well too.

One thing I always rely on is a guide. When I sit down to write, I always put three words on top of the page: Topic, Angle and Purpose. Those three words keep me focused.

I am a big believer in using guides. When I create a presentation…I always use guides.

When I treatment plan I also use guides. My treatment planning guide always sits out on my desk while creating treatment plans. It has become a habit, regardless of the simplicity or complexity of the case. For me it was about avoiding the brainfog of writer’s block. And guess what? My treatment plans make more sense.

I became more confident in my treatment planning process…because I actually had a coherent thought process.

This may sound obvious to many dentists, but what I have found out is that most dentists don’t work with a process. They don’t have an examination process, a treatment planning process or a case presentation process. Many operate by the seat of their pants.

It’s funny but some writers actually like writing by the seat of their pants, without guides or outlines. It works well for them. It works because they have erasers on their pencils…they can revise.

If you would like a free copy of my guide, become a subscriber to the ADL Newsletter. As a bonus I will be sending out the many ways I use it to put my treatment plans together. For those familiar with the Art of the Examination this is new information that I never wrote about in that book.

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In my last post I left you with one word: humility. That was unfair because in the comments I realized that I didn’t tell you how to become humble. And believe me I am not so arrogant that I think I can tell you, but I have learned a few lessons in my time.

And some of those lessons were learned at, of all places, the racetrack.

With Orb winning the Kentucky Derby last Saturday, I was transported back to a time when I spent many of my leisure hours at the track. I admit it…I was part of the subculture, I already had the name…Doc, so I fit right in. I used to spend a lot of prep time handicapping the races, and I did quite well. I was known around the rail as someone who knew how to pick winners.

But picking winners is not easy. I remember one guy, let’s call him Lenny because that’s a great track name too, who would always ask me who I liked, and then he would go and bet another horse…usually the favorite, because in the end, his decision making process led him to consult with what psychologist Robert Cialdini (Influence), calls the social mirror.

Lenny would cash a few tickets, and sometimes he would hit a long-shot…but there was no consistency. No rhyme or reason to his betting. But he was convinced that his process was responsible for his occasional success. His losers? Well, he always cursed his losers…they weren’t his fault.

I did much better, but I eventually lost interest and stopped going. Years later I ran into Lenny at a local ice cream shop. Same old Lenny, still chasing his dreams...he never stopped to figure out what he didn’t know…still telling everyone how good he was doing. Lenny proved the old adage:

“You can beat a race, but you can’t beat the races.”

What did he need?

Humility…it probably could have saved him a lot of money.

So what is the connection to dentistry? Most dentists don’t know what they don’t know. They give themselves credit for the winners and blame their staff and patients for the losers. There’s a lot more to interpersonal communication than meets the eye. The late Walter Hailey once told me, “You have to kiss a lot frogs to succeed.”

I’d rather “know my frogs.”

You can learn humility in other places as well…on the golf course, at the poker table or at home with your spouse.

Life is the teacher. But some people never get it…and what I learned a long time is that winning is a habit…and so is losing.